摘要
目的:探讨影响微创根治性肾输尿管切除术治疗上尿路尿路上皮癌(UTUC)手术难度的相关因素。方法:回顾性分析2018年12月—2024年1月于中国人民解放军总医院第一医学中心和第五医学中心泌尿外科接受腹腔镜或机器人辅助腹腔镜根治性肾输尿管切除术的98例UTUC患者的临床资料,依据手术时间将患者分为困难组(n=29)和正常组(n=69),采用单因素和多因素分析,探究手术困难的影响因素。结果:单因素分析显示,手术时长、髂棘间径、中骨盆棘突间径、骶尾部距离、输尿管走行与中轴线夹角、髂棘间径/中骨盆棘突间径、术中出血量、夹角的余弦函数、性别是LNU或RANU治疗UTUC手术困难的影响因素(P<0.05)。多因素Logistic回归分析显示,女性、术中出血量多、骶尾部距离远是LNU或RANU治疗UTUC手术困难的危险因素(OR>1,P<0.05);输尿管走行与中轴线夹角大、髂棘间径/中骨盆棘突间径大是手术困难的保护因素(OR<1,P<0.05)。结论:临床医生可以结合以上因素,预判微创根治性肾输尿管切除术治疗UTUC的手术难度,并制定针对性的手术方案,从而缩短手术时间,降低手术风险。
Objective:To investigate factors influencing the surgical difficulty of minimally invasive radical nephroureterectomy for upper tract urothelial carcinoma(UTUC).Methods:A retrospective analysis was conducted on UTUC patients who underwent laparoscopic nephroureterectomy(LNU)or robot-assisted laparoscopic nephroureterectomy(RANU)at the First Medical Center and Fifth Medical Center of the Chinese PLA General Hospital from December 2018 to January 2024.Patients were divided into the difficult group(n=29)and the normal group(n=69)based on operative time.Univariate and multivariate analyses were performed to investigate factors influencing surgical difficulty.Results:Univariate analysis indicated that operative time,interspinous diameter,intersciatic diameter,sacrococcygeal distance,ureteral deviation angle from the midline,interspinous/intersciatic diameter ratio,intraoperative blood loss,cosine of the angle,and gender were influencing factors(P<0.05).Multivariate Logistic regression identified female gender,greater blood loss,and longer sacrococcygeal distance as risk factors(OR>1,P<0.05),while larger ureteral deviation angle and higher interspinous/intersciatic diameter ratio were protective factors(OR<1,P<0.05).Conclusion:Preoperative evaluation of these factors may help predict surgical difficulty and optimize operative planning for UTUC patients undergoing LNU/RANU,which can reduce operative time and risks.
作者
李学超
杨涛
左世栋
董金凯
付成伟
孔令生
陈立军
LI Xuechao;YANG Tao;ZUO Shidong;DONG Jinkai;FU Chengwei;KONG Lingsheng;CHEN Lijun(Department of Urology,the Third Medical Centre,Chinese PLA General Hospital,Beijing 100853,China;Department of Urology,the Fifth Medical Centre,Chinese PLA General Hospital,Beijing 100071,China)
出处
《机器人外科学杂志(中英文)》
2025年第9期1465-1470,共6页
Chinese Journal of Robotic Surgery
基金
国家自然科学基金(82173085)。
